Rapid Assessment of

Avoidable Blindness
(RAAB 5)

Hans Limburg MD PhD

What is RAAB?
Rapid Assessment of
Avoidable Blindness
Population-based survey on
blindness and visual
impairment
2

Causes of blindness incl. URE

37 million blind

3
Foster A. et al. Changing patterns in global blindness. Community Eye Health Journal. 2008;21:37-39

Characteristics of RAAB:
provides baseline indicators for planning
and monitoring over time
uses sound epidemiological methodology
simple, cheap and quick procedure
basic ophthalmic examination
carried out by local staff
can be repeated after 8-12 years to
assess change over time (interventions!)
At district level (ideally 0.5-5 million pop.)
4

History
1994: District Rapid Assessments
developed in India

Required for decentralised eye care services

Based on WHO Blindness Survey Form

2000: Modified into Rapid Assessment of

Cataract Surgical Services (RACSS)
2005: Modified to Rapid Assessment of
Avoidable Blindness (RAAB) with focus on
VISION 2020 district level planning
2013: RAAB 5 with reports on URE and
optional DR module; Spanish version
2013: VA<6/12 added
5

Why is it Rapid?

Restricted to people aged 50+

High prevalence low sample size
Standard methodology
Enumeration and examination in one visit
Basic eye examination
Special software

Calculate sample size

Random selection of clusters
Inter-observer variation assessment
Simple data entry
In-built error checks
Automatic data analysis: comparable results
6

Focus on people 50+

85% of all blindness in people 50+
Nearly all cataracts in people 50+
Prevalence high in people 50+,
hence sample size can be small
Elderly people often not far away
from the house
Generally good cooperation
7

The Gambia: Blindness by age

(Faal H, Minassian DC, Dolin PJ, et al. Evaluation of a national eye care
programme: re-survey after 10 years. Br J Ophthalmol. 2000;84:948951)

16
Prevalence (%)

14

85% of blindness in
people aged 50+

12
10
8
6
4
2
0

0-

10-

20-

30-

40-

50-

Age (years)

60-

70-

80+
8

The Gambia: Causes of

blindness

Dineen B, Foster A, Faal H.A Proposed Rapid Methodology to Assess

the Prevalence and Causes of Blindness and Visual Impairment.
Ophthalmic Epidemiology. 2006;13:31-34

Causes in people 50+ reflect

Cause causes
of
Totalpopulation
Population
in total
blindness

population

50+

Cataract

46%

48%

Aphakia

13%

15%

Trachoma/CO

22%

17%

9%

11%

11%

9%

Glaucoma
Other

RA versus conventional Survey

Blindness survey

Rapid assessment

Focus >1 risk group

Focus on 1 risk group

lower prevalence

higher prevalence

Sample size >15,000

Detailed examination
Disease intervention
Expert staff
Large survey population
(10-100 mln.)
Custom data analysis
Takes long (years)
Expensive (0.5-10 mln)

Sample size 2500-5000

Basic examination
Planning and follow-up
Local staff
Smaller survey
population (0.5-5 mln.)
Automatic data analysis
Rapid (months)
Cheap (20-40,000 US$)
10

Indicators used:
prevalence of all blindness, severe visual
impairment (SVI) and moderate visual
impairment (MVI)
main causes of blindness, SVI and VI
prevalence of cataract blindness
prevalence of (pseudo)aphakia
Cataract Surgical Coverage
prevalence of low vision
visual outcome after cataract surgery
cause of poor visual outcome
barriers to cataract surgery
prevalence of diabetic retinopathy (optional)
uncorrected refractive error
age at time of surgery, place of surgery, type of
surgery, costs, cause of poor outcome
8 of 102

Comparing findings of RAAB in 2005 and the

2010 study on posterior segment eye diseases:
(Mathenge W, Bastawrous A, Foster A, Kuper H. The Nakuru

Posterior Segment Eye Disease Study - Methods and Prevalence

of Blindness and Visual Impairment in Nakuru, Kenya.
Ophthalmology 2012;119:20332039)

Conclusions:
This survey provides reliable estimates of blindness
and VI prevalence in Nakuru...
This survey validates the use of RAAB as a method
of estimating blindness and VI prevalence
It is also strongly suggestive that the RAAB
methodology being used throughout Africa and
worldwide is a robust and reliable methodology

Where surveys were done

RACSS

RAAB

Custom survey

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Where to conduct RAAB?

Total population ideally 0.5 - 5 million
Management structure for eye care
Population composition by gender and by
5-year age groups available
Population by sub-unit (enumeration
area, village, town, neighbourhood,
polling station, etc.) available
Detailed maps available
Entire area is accessible for survey teams
No problems with security
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Multistage cluster sampling:

1. Randomly select population units by systematic
sampling from sampling frame
census enumeration areas with population, or
list of settlements with population, or
other list of geographic distribution of total population

2. Sub-divide selected population unit in

segments with equal population, enough to
provide 50 people aged 50+
3. Randomly select one segment
4. Visit all households in selected segment
5. Examine all residents aged 50+ in these
houses, until 50 are examined
6. If less than 50 residents in segment, continue
15
in next nearest segment

RAAB
survey form

17

18

Future developments:
Web-based RAAB repository
Improve access to RAAB data
Planning module
Data entry on smartphone, tablet, PC
Integration of data entry with
examination by eye phone

Web-based repository of survey

sites and findings of RAABs

Christopher Leak, IAPB 2012

Andrew Bastawrous

ICEH, Nakuru,
Kenya